The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial

Jennifer Brunet,Shaunna Burke,Malcolm A West,Michael P.W Grocott,Sandy Jack

doi:10.1186/s12885-017-3130-y

Abstract

BackgroundPromoting quality of life (QoL) is a key priority in cancer care. We investigated the hypothesis that, in comparison to usual care, exercise post-neoadjuvant chemoradiation therapy/prior to surgical resection will reduce pain, fatigue, and insomnia, and will improve physical and mental health perceptions in patients with locally advanced stage rectal cancer.MethodsIn this non-randomized controlled pilot trial, patients in the supervised exercise group (EG; Mage = 64 years; 64% male) and in the control group (CG; Mage = 72 years; 69% male) completed the European Organization for Research and Treatment of Cancer core Quality of Life questionnaire and the RAND 36-Item Health Survey three times: pre-neoadjuvant chemoradiation therapy (Time 1; nEC = 24; nCG = 11), post-neoadjuvant chemoradiation therapy/pre-exercise intervention (Time 2; nEC = 23; nCG = 10), and post-exercise intervention (Time 3; nEC = 22; nCG = 10). The 6-week exercise intervention was delivered in hospital and comprised of interval aerobic training. Patients trained in pairs three times per week for 30 to 40 min. Data were analyzed by Mann–Whitney tests and by Wilcoxon matched-pairs signed-rank tests.ResultsNo significant between-group differences in changes were found for any of the outcomes. In both groups, fatigue levels decreased and physical health perceptions increased from pre- to post-exercise intervention. Pain levels also decreased from pre- to post-exercise intervention, albeit not significantly.ConclusionsThe findings from this study can be used to guide a more definitive trial as they provide preliminary evidence regarding the potential effects of pre-operative exercise on self-reported pain, fatigue, insomnia, and health perceptions in patients with locally advanced rectal cancer. Trial registration: This study has been registered with clinicaltrials.gov (NCT01325909; March 29, 2011).

Highlights

Promoting quality of life (QoL) is a key priority in cancer care
Fatigue, insomnia, and physical and mental health perceptions as indicators of QoL because (i) patients with rectal cancer report these as main concerns [17], (ii) these symptoms appear in the National Institute of Health call for more efforts toward symptom management in cancer [20], and (iii) they represent different dimensions of health relevant to patients with cancer [21]
We found no evidence that an exercise intervention delivered in hospital and that comprised of interval aerobic training resulted in greater effects for any of the outcomes in comparison to usual care, and failed to support the notion that this type of exercise intervention is more effective than usual care for reducing treatmentrelated side effects and improving QoL

Summary

Introduction

Promoting quality of life (QoL) is a key priority in cancer care. We investigated the hypothesis that, in comparison to usual care, exercise post-neoadjuvant chemoradiation therapy/prior to surgical resection will reduce pain, fatigue, and insomnia, and will improve physical and mental health perceptions in patients with locally advanced stage rectal cancer. Treatment for locally advanced rectal cancer often involves neoadjuvant chemoradiation therapy followed by surgical resection with the aim of improving resectability and disease control [2]. These standard treatments can prolong survival, they can result in adverse physical side effects, including pain, fatigue, constipation or diarrhea, upset stomach, nausea, sexual problems, infertility, acute toxicity, and decreased physical fitness [3, 4]. They can result in adverse psychological side effects, including anxiety and distress [5]. Considering that QoL is a significant prognostic factor for cancer recurrence and allcause mortality in patients with advanced colorectal cancer [7], identifying therapies to reduce treatment-related side effects and enhance QoL is a priority in the care of patients with advanced rectal cancer

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Conclusion